* * Anonymous Doc

Thursday, June 16, 2011

The economics of home health aides.

I have a question, and it's not really a medical one. Or even any of my business. But, just curious, what's the right reaction here, if there even is one. Patient who's dying, has a 24-hour home aide living with her. I've spent some time with the very-involved (and somewhat difficult) daughter and son-in-law. They happened to mention to me that once their mother dies, they want to let the aide continue to live in the mother's house, rent-free, in exchange for helping them out, coming over to clean their house, shop for their food, and be there "in reserve" in case one of them needs an aide down the line.

The aide, in a separate conversation, mentioned to me that she's very grateful that the family cares about her, but she wishes she had more opportunities so she wouldn't have to necessarily go along with this plan just because she needs a place to live.

I know this is all none of my business. And I also know that in a free market economy, people make choices and who am I to judge those choices.

But does this not sound a little like indentured servitude?

I think it's the personal services piece of it that I find myself wondering about. If they were letting her live rent-free or for a low rent, and both parties are happy, great. But to let her live rent-free in exchange for some bundle of responsibilities, without paying her-- and using the fact that she has limited economic resources to perhaps take advantage-- makes me uncomfortable with their arrangement.

At the same time, the value of a rent-free apartment is something significant, and if the work required is fairly minimal, what's wrong with that? This is a fair economic exchange, if both sides agree and no one is actually being forced to make that choice, no? The rental value is equivalent to salary. So why do I have the reaction I have?


  1. It is the attitude behind it, I think. They are taking advantage. Like you say, if both parties go in like a business arrangment and agree to this, fine. But that is not what it sounds like, does it? Did you see Pretty Woman? At the end, Richard Gere's character tells Julia Robert's character that he will set her up in a nice apartment, lots of spending money, etc, but basically she is to be his exclusively and pretty much at his beck and call. She was floored. He says, Hey, I never treated you like a prostitute. And she says, Well, you just did. Kinda like that.

  2. Yep,
    What they are doing is both illegal and immoral. An in-house employee should be paid more to be there 24/7, not less. Plus the IRS has a bit to say about wages of rent only. Call around and find an agency that can work with the aid to find a better, and legal, job.

  3. I would do it, but would require a set schedule and a monetary stipend on top of the free rent.